Presenting author biography:

Qing Wu is a researcher, teaching at Kunming Medical University, with degrees from China, Laos (IFMT, Vientiane), and the Netherlands (Erasmus University, Rotterdam), where she is currently also a PhD candidate. For more than 10 years, she has worked on projects for the underserved populations of rural Southwest China.

This study compares costs and benefits of peer-implemented naloxone treatment (PINT), introduced in 2010, and assesses users’ experience, and perceptions of family members.

Data: Financial records on PINT-related expenses between 2011 and 2014 from all 20 counties. Answers to two questionnaire surveys (January 2010-July 2011) among PINT users and among family members in 13 and 3 counties respectively.

Results:
With the help of 45 peer educators PINT was provided to 564 heroin overdose patients in 20 counties at a total cost of 1,578,415 CNY (which includes costs for advocacy, training, perdiem, naloxone purchase and internet). For each patient who benefited, on average 38.7 naloxone injections had been purchased. The cost-benefit ratio was 1:255 (1 CNY invested in the PINT program for a return value of 255 RMB in terms of life years saved). The total produced benefit was calculated as the number of years gained because of prevention of overdose death (potential years of life lost, PYLL), multiplied by the gross domestic product (GDP, for the years 2011-2014), adjusted for three age groups (30-39, 40-49, 50-58): this was 404,266,750 CNY.

For 108 PINT users, who answered a questionnaire, the median time between detection of overdose symptoms and receiving naloxone was 19 minutes. All prefer PINT above hospital-delivered-treatment. In total 205 family members participated in the second questionnaire survey (including 161 with a family member with naloxone treatment experience).

Conclusion: This first calculation of PINT cost-benefit ratio in Yunnan province may be useful for comparisons over time and with other regions. However, for comparison with other health care investments and investments in other sectors, cost-efficiency analysis is needed.

Early feedback from patients and family members seem to support the PINT delivery, although its acceptance varies across the cities. Future studies need to explore more standardized ways of delivery.